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Table of Contents    
Year : 2020  |  Volume : 68  |  Issue : 2  |  Page : 401-402

Osteoporosis in Parkinson's Disease – Need of Screening in Early Stages

1 Department of Neurosurgery and Gamma Knife Unit, Neurosciences Centre, New Delhi, India
2 Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication15-May-2020

Correspondence Address:
Manmohan Singh
Department of Neurosurgery and Gamma Knife Unit, 715, C N Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.284375

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How to cite this article:
Singh M, Garg K. Osteoporosis in Parkinson's Disease – Need of Screening in Early Stages. Neurol India 2020;68:401-2

How to cite this URL:
Singh M, Garg K. Osteoporosis in Parkinson's Disease – Need of Screening in Early Stages. Neurol India [serial online] 2020 [cited 2022 Aug 8];68:401-2. Available from: https://www.neurologyindia.com/text.asp?2020/68/2/401/284375

Parkinson's disease (PD) is a common incapacitating neurodegenerative disease and is characterised by the presence of both motor and non-motor symptoms. As the symptoms worsen, mobility of the patients decrease.

Studies have shown that the risk of fractures including hip fractures is increased in PD patients as compared to non PD individuals.[1–3] This is important as the fractures in PD patients, especially the hip fractures are associated with decreased functionality, prolonged hospital stay, risk of nursing home admission and high mortality rates.[4] Many of these fractures in PD patients are a consequence of increased falls due to postural instability. PD patients are also more likely to sustain fractures due to falls due to concomitant poor bone mineral density (BMD). Bone loss is more common in PD patients compared with the general population. The bone mineral density (BMD) of the total hip and femoral neck is reported to be 10–12% lower in PD patients than in age matched controls.[5] This has been ascribed to multiple factors like malnutrition, physical inactivity, low body mass index, decreased muscle strength, vitamin D deficiency and certain medications.[6],[7] Lorefält et al. concluded in their study that low body weight and low physical activity were risk factors for low BMD in PD, while rigidity was found to be protective.[8] Therefore, screening for poor BMD needs special attention in PD patients. Hence, the treating physician should be aware of this high prevalence of bone loss even in early stages of the disease.

Many studies in literature have reported bone loss in PD patients, more in advanced stages of disease than in early stages. This study is unique in that it has evaluated the relationship between bone mineral density, vitamin D levels and stage and clinical features of the disease.[9] One hundred twenty-four patients with PD and age and sex matched 116 healthy controls were included in the study. Patients were divided into four groups according to Hoehn and Yahr (H and Y) staging. The relationship between the clinical features of the PD (disease duration, the daily levodopa dose, UPDRS part II and III, and sub-scores of UPDRS part III), BMD and vitamin D, was investigated. There were five main results of this study: (1) patients with PD have lower BMD levels and T-scores compared to healthy controls; (2) patients with PD have lower levels of vitamin D compared to healthy controls; (3) the decrease in BMD and T-scores begin in the early stages of the disease process (as early as H and Y stage 1 and 1.5), and they are marked by the progression of the PD; (4) serum vitamin D levels are also decreased in the early stages of the PD, and decreased vitamin D levels are deepened with the progress the disease; and (5) BMD levels, T-scores, and serum vitamin D levels are closely associated with clinical features of the disease, such as UPDRS part II and III, and UPDRS part III subscores in PD patients. The authors concluded that all patients with PD should be screened for developing osteoporosis and for sufficient vitamin D level in the early stages of the disease. Preventive methods for bone quality should be taken into consideration at the onset of PD.

One other study analysed the prevalence of osteoporosis and possible risk factors associated with bone loss in early stage PD.[10] They found that over 50% of sedentary patients with early PD had an abnormal BMD, 41.4% had osteopenia and 11.8% had osteoporosis. The prevalence was slightly lower as compared to previous studies, which has been ascribed to the fact that they had included patients with lower H and Y stages in their study.[6],[10] The increase in prevalence of decreased BMD in patients with advanced stage PD has been attributed to diminished activities in daily life, greater motor impairment, less sunlight exposure due to greater immobility, and continuing weight loss.[11],[12] All these factors lead to decreased vitamin D levels. Female gender, weight loss and low 25-OH-vitamin D levels were found to be significant risk factors associated with a lower BMD in this study.[10] Lorefält et al. found that the body fat was lower in weight loosing PD patients compared with patients without weight loss. They further stated that body fat is endocrinologically active and in postmenopausal women, the oestrogen levels are directly correlated to the fat mass because of the aromatization of oestrogens, why low body fat may increase the risk for low BMD, especially in females.[8]

It has been recommended routine measurement of vitamin D in older patients with PD, even in early stages of their disease.[10] One study recommended to not to measure the BMD of the lumbar spine but to measure BMD only of hip and the total body, as it is often falsely elevated in the latter site in elderly subjects because of spondylosis, vertebral compressions, aortic calcifications and other factors.[8] Other studies have also recommended supplementation of the vitamin D deficiency and by others, or by promoting physical activities.[13],[14]

  References Top

Fink HA, Kuskowski MA, Orwoll ES, Cauley JA, Ensrud KE, Osteoporotic Fractures in Men (MrOS) Study Group. Association between Parkinson's disease and low bone density and falls in older men: The osteoporotic fractures in men study. J Am Geriatr Soc 2005;53:1559-64.  Back to cited text no. 1
Schneider JL, Fink HA, Ewing SK, Ensrud KE, Cummings SR, Study of Osteoporotic Fractures (SOF) Research Group. The association of Parkinson's disease with bone mineral density and fracture in older women. Osteoporos Int 2008;19:1093-7.  Back to cited text no. 2
Sato Y, Kaji M, Tsuru T, Oizumi K. Risk factors for hip fracture among elderly patients with Parkinson's disease. J Neurol Sci 2001;182:89-93.  Back to cited text no. 3
Idjadi JA, Aharonoff GB, Su H, Richmond J, Egol KA, Zuckerman JD, et al. Hip fracture outcomes in patients with Parkinson's disease. Am J Orthop 2005;34:341-6.  Back to cited text no. 4
Taggart H, Crawford V. Reduced bone density of the hip in elderly patients with Parkinson's disease. Age Ageing 1995;24:326-8.  Back to cited text no. 5
Schneider JL, Fink HA, Ewing SK, Ensrud KE, Cummings SR, Study of Osteoporotic Fractures (SOF) Research Group. The association of Parkinson's disease with bone mineral density and fracture in older women. Osteoporos Int 2008;19:1093-7.  Back to cited text no. 6
Invernizzi M, Carda S, Viscontini GS, Cisari C. Osteoporosis in Parkinson's disease. Parkinsonism Relat Disord 2009;15:339-46.  Back to cited text no. 7
Lorefält B, Toss G, Granérus A-K. Bone mass in elderly patients with Parkinson's disease. Acta Neurol Scand 2007;116:248-54.  Back to cited text no. 8
Ozturk EA, Gundogdu I, Tonuk B, Umay E, Kocer BG, Cakci A. Bone mineral density and serum vitamin d status in parkinson's disease: Are the stage and clinical features of the disease important? Neurol India 2020;68:394-400.  Back to cited text no. 9
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van den Bos F, Speelman AD, van Nimwegen M, van der Schouw YT, Backx FJG, Bloem BR, et al. Bone mineral density and vitamin D status in Parkinson's disease patients. J Neurol 2013;260:754-60.  Back to cited text no. 10
van der Marck MA, Dicke HC, Uc EY, Kentin ZH, Borm GF, Bloem BR, et al. Body mass index in Parkinson's disease: A meta-analysis. Parkinsonism Relat Disord 2012;18:263-7.  Back to cited text no. 11
van Nimwegen M, Speelman AD, Hofman-van Rossum EJ, Overeem S, Deeg DJ, Borm GF, et al. Physical inactivity in Parkinson's disease. J Neurol 2011;258:2214-21.  Back to cited text no. 12
Evatt ML, Delong MR, Khazai N, Rosen A, Triche S, Tangpricha V. Prevalence of vitamin d insufficiency in patients with Parkinson disease and Alzheimer disease. Arch Neurol 2008;65:1348-52.  Back to cited text no. 13
Canning CG, Allen NE, Dean CM, Goh L, Fung VS. Home-based treadmill training for individuals with Parkinson's disease: A randomized controlled pilot trial. Clin Rehabil 2012;26:817-26.  Back to cited text no. 14

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[Pubmed] | [DOI]


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